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Tuesday, May 27, 2008

Experts Question Placebo Pill for Children

Just came across an interesting article in the NYTimes: Experts Question Placebo Pill for Children. I have many times wondered this myself: if placebos are so effective, why do we not use them as benign medicines in specific situations? I understand the fears of conditioning, where families start to turn to placebos for every minor ache, but that's better than using old antibiotics or other medications in my opinion. How did this idea arise?

Jennifer Buettner was taking care of her young niece when the idea struck her. The child had a nagging case of hypochondria, and Ms. Buettner’s mother-in-law, a nurse, instructed her to give the girl a Motrin tablet.

“She told me it was the most benign thing I could give,” Ms. Buettner said. “I thought, why give her any drug? Why not give her a placebo?”

Studies have repeatedly shown that placebos can produce improvements for many problems like depression, pain and high blood pressure, and Ms. Buettner reasoned that she could harness the placebo effect to help her niece. She sent her husband to the drugstore to buy placebo pills. When he came back empty handed, she said, “It was one of those ‘aha!’ moments when everything just clicks.”

Ms. Buettner, 40, who lives in Severna Park, Md., with her husband, 7-month-old son and 22-month-old twins, envisioned a children’s placebo tablet that would empower parents to do something tangible for minor ills and reduce the unnecessary use of antibiotics and other medicines.

With the help of her husband, Dennis, she founded a placebo company, and, without a hint of irony, named it Efficacy Brands. Its chewable, cherry-flavored dextrose tablets, Obecalp, for placebo spelled backward, goes on sale on June 1 at the Efficacy Brands Web site. Bottles of 50 tablets will sell for $5.95. The Buettners have plans for a liquid version, too.

Of course, there are critics:

But some experts question the premise behind the tablets. “Placebos are unpredictable,” said Dr. Howard Brody, a medical ethicist and family physician at the University of Texas Medical Branch at Galveston. “Each and every time you give a placebo you see a dramatic response among some people and no response in others.”

He added that there was no way to predict who would respond.

“The idea that we can use a placebo as a general treatment method,” Dr. Brody said, “strikes me as inappropriate.”

Still, later in the piece, even Dr. Brody admits that the product will likely be quite popular. And why not? We already do many actions to treat things which in reality have no true efficacy. Why not formalize the practice? I think if this catches on, pediatricians should simply address it with parents directly, and tell them when it is appropriate to use placebos and when they must bring their child in to see a physician.